Environmental Lead Pollution and Heart Failure in Haiti

Weill Medical Coll Of Cornell Univ, New York NY

Investigators

Abstract

Dr. Lily Yan is a general internal medicine physician committed to a long-term career working at the intersection of environmental health and global cardiovascular disease (CVD) prevention. Environmental lead pollution is an emerging risk factor for heart disease, particularly in low-income countries. Dr. Yan’s research identified adults in urban Haiti have high blood lead levels (BLL) that are 5-fold higher than the US, higher BLL are associated with elevated blood pressure, and heart failure is the predominant type of CVD and associated with hypertension. She hypothesizes lead exposure may be associated with heart failure, which is currently unknown. She proposes a high-impact career development award to expand her training and research to characterize the association of lead with incident heart failure and CVD, and to identify modifiable sources and potential interventions for future exposure reduction in Haiti. Her training aims build expertise in 1) environmental health including pollution exposure assessment and 2) implementation science methods, including qualitative research and mixed methods to identify future interventions to reduce lead exposure. Her career development plan includes coursework, experiential learning, and a multidisciplinary mentorship team with decades of experience in global CVD research, environmental health, and implementation science. She is supported by a robust research and training environment in Haiti and the US that leverages a 45+ year clinical-research program with continuous NIH funding and ongoing studies. Dr. Yan’s research plan includes Aim 1: evaluating the association of BLL with incident heart failure and CVD, over a median follow-up time of 7 years, and Aim 2: identifying modifiable lead sources and potential interventions to reduce individual, household, and community exposure, guided by the Exploration- Preparation-Implementation-Sustainment framework. For sources, she will conduct a lead exposure assessment using XRF analyses among 100 participants with high BLL and 100 with low BLL. For future interventions, she will conduct interviews with participants and stakeholders to explore preferences, barriers, and facilitators for interventions. Data will be integrated using explanatory sequential mixed methods and intervention mapping to identify prioritized interventions for future evaluation. This proposal builds upon her training aims, and is a sub-study in the ongoing Haiti CVD Cohort (R01 HL143788). This K23 is the first step to address global knowledge gaps in the relationship between environmental lead, heart failure and CVD in settings of extreme poverty and will generate data-driven environmental pollution intervention(s) aimed at reducing premature CVD. Her proposal is highly feasible and sets her career pathway towards independence in an emerging field that is high-impact for global CVD population health.